Housemate Application RM_StatsYour InformationLegal Name *Other names usedMailing Address State or Region United States Canada Physical Address (if different) State or Region United States Canada Email *Home PhoneCell PhoneWork PhoneBest number to call during the daySelect an optionHomeCellWorkThere are typically 4 times as many people looking for housing as there are homes available. We cannot guarantee that everyone will find housing through our program.What is the maximum rent per month you would pay?What is the maximum number of hours of service per week you can provide?What pets do you have?If you own a dog, has it ever bitten anyone?Select an optionYesNoThe following factors will help us better understand your housing needs. Please check the statements that apply to you. I have a car and can drive I can drive but don't have a car I am a smoker Housing HistoryCurrent housing situation. If other, please explainSelect an optionRentOwnOtherExplanation of current housing situationHow long at current address?FromToIf renting, current landlord's name and numberPrevious housing situation. If other, please explainSelect an optionRentOwnOtherExplanation of previous housing situationHow long at previous address?FromToAddressCityStateIf renting, previous landlord's name and numberWe ask for the following information to help determine that RappHomeShares does not discriminate in its services.GenderDate of BirthAgeEthnicitySelect an optionHispanicNot HispanicRace (check all that apply) White Black/African American Asian American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Multiracial Other Do you have a disability?Select an optionYesNoDo you receive Medicaid?Select an optionYesNoAnnual income (must include all sources of income)As part of our application process, we do background and reference checks, and a personal interview. To begin this process:Do you have any motor vehicle violations?Select an optionYesNoDo you have any pending criminal charges?Select an optionYesNoHave you had any criminal convictions?Select an optionYesNoHave you ever been evicted?Select an optionYesNoIf yes to any of these questions, please explainEmployment HistoryCurrent employment statusSelect an optionFull timePart timeRetiredUnemployedStudentCurrent EmployerPosition/TitleCityStateDate of HirePrevious EmployerStatusSelect an optionPart timeFull timePosition/TitleDates employedFromToCityStateReferencesAll references should be people who have known you at least 1 year. Together, the references should cover a span of at least 5 years to the present. We require references from past or present roommates, employers, or co-workers. NOT ACCEPTED as references are family members, friends, or romantic partners. Tell your references that RappHomeShares will be calling them. If you have trouble reaching them, we will have the same trouble, and your application will be delayed.Reference 1Daytime phoneCityStateEmailHow long have they known you?How do they know you?Reference 2Daytime phoneCityStateEmailHow long have they known you?How do they know you?Reference 3Daytime phoneCityStateEmailHow long have they known you?How do they know you?Reference 4Daytime phoneCityStateEmailHow long have they known you?How do they know you?Other information you want us to knowIs there another adult seeking housing with you?Select an optionYesNoAcknowledgment *I hereby acknowledge that all the information I have given in this application is true and complete to the best of my knowledge and belief. I understand that providing any false or misleading information will make me ineligible for the services of RappHomeShares.I agreeSigned * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
